VA accused of bad pain-management practices

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In an emotional, sometimes tearful hearing before members of Congress Thursday, widows of veterans and others blamed the Department of Veterans Affairs' Veterans Health Administration for improperly treating chronic pain, occasionally with fatal results.

In addition to the two widows, lawmakers heard from two veterans who describe themselves as victims of VA medical malpractice and former VA doctors who reported instances of personal abuse, alteration of medical records by VA staff, “bullying” of well-meaning physicians and other offenses. One witness characterized some practitioners of VA medicine as favoring “quick and cheap over good and thorough.”

“No one who watched today’s testimony could help but be moved and profoundly angered,” said Daniel M. Dellinger, national commander of The American Legion, which submitted written testimony for the hearing. “If there is even a modicum of truth in the accusations leveled today, VA has much to explain. Whether these problems are contained within certain facilities or wider in scope, they are inexcusable and must be corrected.”

The Thursday morning hearing before the House Committee on Veterans Affairs' Subcommittee on Health Care was titled “Between Peril and Promise: Facing the Dangers of VA’s Skyrocketing Use of Prescription Painkillers to Treat Veterans.” It opened with an emotional statement by Heather McDonald, widow of Army Spec. Scott McDonald, who she found dead in their home, she explained, after a deadly cocktail of painkillers and psychotropic drugs prescribed by VA to help McDonald cope with severe, chronic physical and emotional wounds related to combat.

A fellow service widow and 21-year Air Force veteran, Kimberly Green, told how her Army veteran husband, Ricky, died as the result “mixed-drug intoxication… because of the prescription pain and sleeping medications that the VA and its doctors prescribed for him and dispensed for him out of the VA pharmacy.”

Both widows accused VA of uneven, sometimes-contradictory methods of pain treatment marked by frequent changes of doctors and an over-reliance on opiates – narcotics – while ignoring less dangerous, alternative medical methods.

Two former servicemembers then told of their own struggles with service-connected chronic pain and what they consider outmoded and harmful methods of pain treatment employed by at least some VA medical facilities.

VA offered rebuttal arguments, pointing to the complexity of the medical issues involved in pain management with its mix of severe and individualized physical and psychological factors. VA’s witnesses also told of VHA’s continuously evolving and increasingly effective program of chronic pain treatment with an emphasis on quality, safety and proper training of practitioners. VA offered no explanations about the cases cited in the hearing testimony.

The three-hour session ended with agreements between VHA officials and members of Congress to follow up on the issue and track progress carefully.

In its written testimony submitted to the congressional subcommittee prior to the hearing, The American Legion noted that it has long been concerned about the negative aspects of exclusive, drug-based therapies for severe, chronic pain, and its related psychological and emotional effects. In 2010, Legion leadership commissioned an ad hoc committee to investigate existing and alternative methods of treating traumatic brain injury and post-traumatic stress disorder – conditions often accompanied by chronic physical pain. During the three-year study, the Legion committee held six meetings and met with leading authorities in VA and the Department of Defense (DoD), and interviewed a number of stricken veterans. As a result, the Legion launched a campaign favoring non-pharmacological treatment modalities for pain management, including the employment of “hyperbaric oxygen therapy, virtual reality therapy and other complementary and alternative medicines.”

The American Legion also mentioned its adoption of a resolution calling for federal funding of pain management research, treatment and therapies at DoD, VA, and at the National Institutes of Health to be increased significantly, and that Congress and the administration re-double their efforts to ensure that an effective pain-management program be uniformly established and implemented. The resolution also called on DoD and VA to increase their investment in pain-management clinical research by improving and accelerating clinical trials at military and VA treatment facilities, as well as at affiliated university medical centers and research programs.

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karen naylor

I'm not a hero. Am just a gal that was attacked and thrown over a cliff by some bad guys who were in a military prison for various crimes and I do not know why they were out that day. The man who threw me over the ravine first picked me up by one arm and one leg and swung me around and around before letting go. The rock I landed on shattered my vertebra where the body bends. When found I was thrown over a man's shoulder to carry up to safety. I was taken to a military hospital, but the doctor was a civilian as it was a weekend. Without ordering x-rays and reading in my record I was at the prison he assumed the worse of me and sent me to jail for the night in the jail. I had no control over my bladder or bowels so wet myself causing flies to land on, which caused me to scream . Even a small fly was torture. The sgts in charge played cards all night to keep watch over me. They kept me warm, gave me aspirin, and what comfort they could. The next day a ambulance was again sent for. One of the medics having been a medic in Nam knew I was injured bad. He tucked me in a fresh and dry sheet. The same doctor was on duty. When he could not get me out of the sheet he flipped me out and told me to "shut the fuck up." I was sent to a room where when I wet the bed a nurse would grab and plunk me down onto a medal chair that was by my hosp bed.I was also forced to walk and take a bath even though I could not move or be touched without screaming. Finally on the 4th day during Grand Grounds I over heard a nurse tell the military doctors I had been committed to the mental ward and was being moved there in a few hours. The shock wearing off a bit I became angry and told the docs I needed x-rays etc. They called for a head doc (am sorry I can not spell the word) who gave me some test that lasted a few hours. After he read the test he ordered x-rays. While on the table I told the tech I needed to go to the bathroom and he told me where it was. AS I was trying to get up to go I was surrounded by people who shouted at me to hold still. I was told I had an unstable break, wrapped on a board and evaced by helicopter to Fitz were as soon as I was stable the Army docs put me back together by opening my back like a rack of ribs. They hammered bone off a hip bone to make me a new vertebra , which they fused two Herrington Rods. The first surgery paralyzed me so they tried again and that time my toes wiggled. The pain was great from the lack of proper treatment at the first hosp. and from the ill treatment Bless the staff at Fitz they tried everything to help with the pain. During the day I was given morphine shots and at night I was given opium suppositories. Therapies , pain overload, they even paralyzed me with some kind of shot after I told I didn't know how I would be able to handle the pain. After taking my blood pressure a dozen times it seemed they left me in the room by myself. When I woke up I had forgotten I couldn't walk and tried to go to the bathroom on my own. When I couldn't I said I'd try all the other things. I was 30, and loved the army and the Army loved me. I thought I could conquer the Earth. As time went on it was plain the pain was not lessening. I was being put in a normal bed at night and strapped onto a bed that made me stand on a shelve to keep my leg muscles strong, during the day. The staff gave me Ike's wicker chair to get around as it made into a chair and a bed. I was not in a cast at that time and not able to sit yet. My bed was kept by the nurse's station to care for me and my husband helped when he wasn't at work. The Red Cross flew him to me in the beginning and I was not expected to live. Finally a cast and I was on put on light duty while learning how to walk again. On the day the nurses allowed me to go to the bathroom by myself I was so happy, but what happened was when I tried to sit down the pain caused me to scream so loud it scared the nurse, other patients and me. It was even more terrible that what I already felt. Dear God. I was told until I could do normal things without screaming I could not leave the hosp. I still scream with the wrong move or pressure on the area. To make matters worse while a patient at the Salt Lake City VA some of the docs would not listen to me when I told them what the Army told me not to do. They threatened me and told me if I did not do it they would cut my check and medical off. Both Herrington Rods are broke now. One at the top and the other at the bottom. I have gone through experiments both VA and civilian and therapies. A leading pain doc sent a letter to the VA that pain meds was the last hope for some kind of life for me. the VA in Portland gave me fee basis so I could get help for the pain and it would not be so hard on me traveling. The last doc at the VA hosp at the White City Clinic told me "Why don't you kill yourself and put the taxpayers out of your misery."

Mac Martin

In reading these comments I feel sad. I have chronic back pain, which one VA Dr. said was my hip joint. My Primary Dr was changed, the new Dr sent me to a surgeon who had a MRI ordered which he said indicated spinal problems. My main complaint is I have degenerative disk disease and my lower spine is eaten away. After reading the other comments I feel ashamed that I am complaining, though I am in constant pain which only allows me to stay in bed most of the time. These other Vets appear to be so much worse than me and have received such bad care, it is hard to believe. Is there anyone in the DEA (which has no right to give an every body has to come off all pain medications order). I feel that the problem is with the DEA, they can't control street drugs so to make it look like they are doing something hopped on the VA since we are at their mercy. I would have to assume that these guys have never had chronic pain or they would not be so unfeeling about it. The pain causes head of households to make everyone in the family to suffer. They are not able to work or if they can not to half the level they did before this happened. Laying in bed with bad pain not letting you sleep and causing every step to be very painful. I am now 70 years old, with maybe ten to fifteen years left to live. My quality of life is so low now I wonder why I want to keep on. The government sucks, with all the high paid idiots in Washington they mostly are only concerned with how much they can steal and what they can cover up. This goes from the top to the bottom.
The American Legion (of which I am a member) is not doing what they should. Each vet should be looked at as an individual not a large group of drug addicts. I don't know if I am going to continue my membership if they are supporting this unfair and unfeeling policy. I am very disapointed with them seems like all the good things are ruined by this policy if they support this I can't support them.
I hope with all my being that the above vets get what they need not having to stoop to the level of politics.

karen naylor

Mac please do not think what you have is any less than other acute pain sufferers. Your story sounds just like my husbands. I watch him some days not be able to get out of bed it is so bad. He had his gall bladder removed and has GERD, which is also very painful and makes it impossible to have pain meds. I see him suffer everyday. I see him not be able to walk. He has gone to doctor after for help with the degenerative disk disease, but no one wants to help as he is CHAMPUS and the doctors want more money than they pay.I know how you suffer. Do not slight yourself. Bless your heart, and God help us all.

Christopher Klemetson

I'm 70% service connected 30% unemployable. I have been previously denied being admitted after being diagnosed with acute pancreatitis and kidney stone blockage. I had to go to another hospital the same day to be admitted. I have also have had numerous times of inadequate pain relief as an inpatient.

Tell

I know one thing: I am not going to support or keep dues going for the Legion or other organizations that's supposed to help vets and disabled vets. If the Legion has the ear of the filth in DC and media then they should use it. The Legion and others including media should not allow distractions to cease the focus on needed attention until remedy is found for each issue.
I've been in chronic pain for years. Doctors ruined my liver, NAFL (non-alcoholic fatty liver) with Naproxin, cholesterol and other dope they pushed on me saying it's safe. Told by liver docs and others to stop taking certain meds and stay on narcs for pain. My pains being migraines, artificial joints both feet, osteo arthritis, both knees, hips, most joints, lesion in hips, degenerative disks in neck, thorasic, and lower spine, gout, and my joints slip out of joint like my spine, and elbows killing me to type now. The TMJ isn't helping matters to which 5 dentist said I had and one VA doc without touching me said I did not have. Now they dropped me from stupid Fetenyla patches that didn't do a thing but claim now they are so dangerous, bull. Took me off time released morphine and then from oxy down to hydrocodone to nothing but Naproxine and again tylenol that I am not supposed to take per liver docs orders.
I changed for the local clinic with my doctor retired from a prison and he fits right in with the VA torture chamber. Switched me to a far worse doctor in the Indianapolis VA hospital who started dropping and changing my meds while repeating they are there to help what do you need? Oh but not anything for muscle cramps or spasms or pain meds. What do you want surgery for and I never asked for surgery and they do love to cut. Now I asked for another change in primaries and yet to hear from them. I guess I'm a terrorist now because I disagree with the VA and stinking government on their treatment, blood tests, and interrogation tactics by the VA trained docs. I also requested info about getting away from the VA or about the new voucher system they passed. And about being forced to get on stinking Obama care which sucks big time.
Suicides are up and there doesn't seem to be any where to get help or information, period. My VA disablility is supposed to be exempt from bankruptcy but not in my state or town so the attorney can make you file a Chap 13 instead of a chap seven for a few thousand more dollars. And I have called every orgainization out there including the Legion and no-one gives a damn. All they say it's not their affair and to hire a attorney. Yeah, right at thousands of dollars more to get screwed again and called about fifty and told they would not clean up another's mess or for professional courtesy will not get involved.
So the damned game continues while our politicians and others get their golden health care and like illegals get whatever they want or need without hesitation or interrogation. Pretty damn sad. So the wait is on and no remedy or pain meds in sight, just more disregard, ridicule, corporal punishments, white hatred and racism, and the damn system knows what they are doing and why suicides are up. The Legion has failed us in dropping the ball on our care and moved on it seems to support war for Israel and support for stinking Obama and playing the race card. So we whites can't complain about that issue in VA care either while they can seem to get the meds some of us need for far less problems. Must be nice. I'm sick of it ... all. Get with it Legion, I'm wasting my money with do nothing chapters and more dis-concern from those who are supposed to help and be concerned. You won't post this will you?

Jeff Geurin

The VA's response to stories in the media like this has been to start drastically reducing my prescriptions of Oxycontin and Percocet (which I have taken for 8 years now for chronic pain), without doing anything else to treat the pain. They intend to have me totally off here soon, and I am in so much pain I don't know what to do. When I ran out early, they started treating me like a drug addict and refused to give me more. This is no way to treat vets. I agree pain medicine isn't ideal, but if I'm in pain, their primary duty is to stop the pain. There is no bigger threat to a person's well-being than unmanaged pain.

Jeffrey Brown

I'm in the same boat, abruptly taken off the time-released morphine I've taken for years (I'm allergic to NSAIDs) and left with (ineffective) gabapentin and tylenol. I suffer from severe major depressive disorder, and the endless chronic pain doesn't help.

0311infantrysir

Well, I just got a call from the VA and they will no longer dispense Narcotic Pain medication and Benzodiazapines so I have to "choose" one ailement to have treated, PTSD or Broken Neck? Wow. Happy Fourth of July America.
Semper F.U.C.K.

Anonymous

I have hip pain and back pain. The VA in Ohio would not give me any pain meds except Naproxan, I'm taking that by the hand full, they gave me an appointment for physical therapy somewhere in Ohio, couldn't find it and gave up. They want me to drive hundreds of miles for therapy. I feel I'll have to seek and procure medication in the black market. I don't have any regrets serving my country. I do have regrets ever seeing VA doctor who I have only seen one time last year, she offered me a cane. Thanks I'll buy my own cane. The mental health therapist that was seeing me wont see me either. Thank you very much.

AJBCARS

My wife worked for the VA for a little less than 2 years as a nurse and was surprised. She resigned and told me if any thing should happen to you, the VA is the last place I will take you. I am a retired 20 year Army disabled combat vet and do not use the VA. She told me that there is a severe lack of leadership and accountability. She was shocked at how things are done and how the staff did as little as possible.

Cal Perry

I am a vietnam veteran(1969-1970). I have chronic pain also in my legs,feet and hands. Pain is something you deal with medication or natural way. I have taken the shot in the behind(temporary fix).Medicine that effect your vital organs is not good for you in the long run. Tell me what I need to do help myself now.

Randall Wendt

I am in severe chronic pain. The VA performed a MRI but that is all. I receive steriod injections in my back on a frequent basis but they do not help. I have expressed this to my physican but he demands I lose 50 lbs and quit smoking or he will not help me with further testing. I asked for a physical assessment to my primary physician and my pain managment physician but they both state this is not something the VA does. I haven't gone to physical therapy or any other type of treatments -- steriod injections in the surgery center and narcotics is all. I want to work but the pain I am in I am incapable of working but part-time and I cannot live on part-time work. PLEASE Something must be done with the limitations or attitudes of the VA doctors. I want to find a resolution instead of a band aid.

Stuck between a rock and a hard place

Major crush-type injury caused c-spine fractures and disk rupture resulting in cervical cord flattening due to the disk contents and bone pushing on my cord. Also suffered torn radial nerves in both arms and ruptured l-spine disks impinging nerves into my legs. Due to having a cardiac stent placed (bare metal) 1 month prior to the accident , cardiology refused medical clearance for the 6 required surgeries for 5 months.
The short story is that I now suffer from permanent cord and peripheral nerve damage which causes a great deal of pain, especially on days when I feel better and attempt even a small portion of my pre-accident activities. I had been on the strongest narcotic pain meds available. Over the last 3 years I have reduced the pain meds to mild strength narcotics routinely with low dose narcotics for break through pain. I was told by my VA primary MD last year that the VA is going to stop supplying narcotic analgesics. I have tried every other type of med used for nerve pain to no avail. I have failed a spinal cord stimulator trial. I have attended VA counseling for depression, PTSD and chronic pain for 2 1/2 years monthly and have reduced my anxiety dramatically and am off all anti-anxiety meds for several months .The pain however has remained constantly up and down, but more tolerable and my narcotic meds have not changed for 2 years. All this yet the VA wants me to stop using the only medications that are working. Their are medical centers performing investigational therapies for pain management, yet VA won't pay for these therapies. There are only 2 therapies to date which have shown promise for Cervical Sympathetic Dystrophy and I can't afford them.
I have not developed tolerance to these current pain meds and they allow me to get out of bed and perform my activities of daily living . I can only assume that the VA wants to take me off the only pain meds that work and subsequently slip back into depression and once again become anxiety and bed ridden. The pendulum never stops in the middle, it always swings wildly from one apex to the other. Those I between are sol.

Barberian

I suffer from several things including Fibromyalgia. Fibro is a pain feedback loop that ramps up the pain exponentially for me. I am in extreme pain often if I have to stand, walk or sit straight up for more than 10-20 min. I asked for a reclining electric wheelchair and was denied. A self powered wheelchair would cause the same pain I'm trying to avoid. Reclining takes most of the weight off my spine and hips. You almost have to be dead before the VA will give you one. That one thing alone would decrease my pain meds dramatically.

Anonymous

Have any of you taken a good look at the Joint Commission?? They REQUIRE Dr's and nurses to over medicate patients, then document until the patient says stop! Great system, absolutely disregards any education, clinical experience,or assessment skills a trained medical professional may have. Perfect for drug abusers and patients/families that insist on NO PAIN at all, even post op!

Stuck between a rock and a hard place

Yes, Joint Commission which is the major certifying agency for hospitals, rehab and long term care centers, home health agencies, et al. They have guidelines in place just as Anonymous has described exhaling that you have the right to be pain free and the facilities have to asses you regularly for pain and do whatever it takes to provide you relief. Here are the 2 major practice guidelines for the treatment of pain in this county, and they contradict one another. The VA has directed its MDs to get their patients off narcotic pain meds no matter what, and the rest of the country is humane enough to manage your pain in whatever manner is necessary (and safe).

Wade Taylor

I see things like this at the VA further evidence of the spiraling down of medical treatment in this country--both in the public and private sectors. Obamacare will make it worse as it will increase demand(patients) with less supply(doctors). Hurry up and wait will be the new normal and destroy the greatest health care system we have.